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Objective: Hemangioma is a common benign tumor in the head and neck. The therapeutic effect by conventional treatment was not very satisfactory. The purpose of this study is to explore the surgical strategy of low-temperature plasma radiofrequency in the treatment of hemangioma located in the nasal cavity, pharynx, and larynx. Methods: The clinical data of 29 cases with hemangioma in nasal cavity, pharynx, and larynx treated by low-temperature plasma radiofrequency ablation were retrospectively analyzed. The strategy of ablation before resection was performed for 16 cases of nasal capillary hemangioma. The other 13 cases of cavernous hemangioma in the pharynx and larynx were treated by the strategy of direct ablation. Results: All 29 patients underwent a successful operation with minimal intraoperative bleeding and no postoperative bleeding complications. There was no nasal septum perforation, dyspnea, dysphagia, dysphonia, or other complications. The patients were followed up for more than 3 years without recurrence. Conclusion: Low-temperature plasma radiofrequency is a practical, minimally invasive, and accurate method for treating hemangiomas in the nasal cavity, pharynx, and larynx. For capillary hemangiomas, the strategy of ablation before resection may be an effective way to reduce bleeding, and for cavernous hemangiomas, the strategy of direct ablation is a simple and efficient method. [ABSTRACT FROM AUTHOR]

Objective: To determine oncological and functional outcomes in patients with T3 and T4 laryngeal carcinoma, in which choice of treatment was based on expected laryngeal function and not T classification. Methods: Oncological outcomes (disease-specific survival and overall survival) as well as functional outcomes (larynx preservation and functional larynx preservation) were analysed. Results: In 130 T3 and 59 T4 patients, there was no difference in disease-specific survival or overall survival rates after radiotherapy (RT) (107 patients), chemoradiotherapy (36 patients) and total laryngectomy (46 patients). The five-year disease-specific survival rates were 83 per cent after RT, 78 per cent after chemoradiotherapy and 69 per cent after total laryngectomy, whereas overall survival rates were 62, 54 and 60 per cent, respectively. Five-year larynx preservation and functional larynx preservation rates were comparable for RT (79 and 66 per cent, respectively) and chemoradiotherapy (86 and 62 per cent, respectively). Conclusion: There is no difference in oncological outcome after (chemo)radiotherapy or total laryngectomy in T3 and T4 laryngeal carcinoma patients whose choice of treatment was based on expected laryngeal function. [ABSTRACT FROM AUTHOR]

Background: A pathological communication between the trachea and oesophagus – a tracheoesophageal fistula – may be congenital or acquired, benign or malignant, necessitating a multidisciplinary approach. Conservative attempts at closure of this abnormal connection are ineffective; the interposition of healthy vascular tissue offers the least chance of recurrence. Methods: Outcomes of an islanded fasciocutaneous internal mammary artery perforator flap applied for tracheoesophageal fistula management were assessed in four radiated patients with laryngeal carcinoma using retrospective records. Results: Four male patients, with an average age of 60.75 years, underwent tracheoesophageal fistula closure between September 2017 and February 2021. A left-sided second internal mammary artery perforator flap was used in all cases, with an average dimension of 10.5 × 4.5 cm. There were no complications of tracheoesophageal leak, flap issues or donor site morbidity on follow up. Conclusion: Recent advances in angiosomal territory mapping and microvascular dissection techniques, combined with an understanding of tracheoesophageal fistula pathology, have changed management perspectives in these difficult-to-treat patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Anterior commissure involvement (ACI) is an important factor in the local control of early-stage glottic squamous cell carcinoma (EGSCC). We initiated a radiotherapeutic treatment regimen focusing on ACI, which has included hyperfractionated radiotherapy since 2008. One-hundred and fifty-three patients with T1–T2 EGSCC were included in this study. Hyperfractionated radiotherapy (74.4 Gy in 62 fractions) was used for EGSCC with ACI. The 10-year overall survival and cause-specific survival rates were 72% and 97%, respectively. The 10-year local control rates were 94% for T1a, 88% for T1b, and 81% for T2 disease. Local control rates in patients with ACI were slightly better than those in patients without ACI with T1a and T1b diseases; however, the difference was not significant. The 10-year laryngeal preservation rate was 96%. In conclusion, hyperfractionated radiotherapy was effective for T1 disease with ACI but insufficient for T2 disease with ACI. Our treatment strategy resulted in excellent laryngeal preservation. Anterior commissure is involved in about 20% of early-stage glottic squamous cell carcinomas (EGSCCs). Treatment outcomes and prognostic factors for EGSCC with anterior commissure involvement (ACI) were evaluated by focusing on hyperfractionated radiotherapy (74.4 Gy in 62 fractions). One-hundred and fifty-three patients with T1–T2 EGSCC were included in this study. The median total doses for T1a, T1b, and T2 were 66, 74.4, and 74.4 Gy, respectively. Overall, 49 (32%) patients had T1a, 38 (25%) had T1b, and 66 (43%) had T2 disease. The median treatment duration was 46 days. The median follow-up duration was 5.1 years. The 10-year overall and cause-specific survival rates were 72% and 97%, respectively. The 10-year local control rates were 94% for T1a, 88% for T1b, and 81% for T2 disease. Local control rates in patients with ACI were slightly better than those in patients without ACI with T1a and T1b diseases; however, the difference was not significant. The 10-year laryngeal preservation rate was 96%. Six patients experienced grade 3 mucositis, and four patients had grade 3 dermatitis. Hyperfractionated radiotherapy was effective for T1 disease with ACI, but insufficient for T2 disease with ACI. Our treatment strategy resulted in excellent laryngeal preservation. [ABSTRACT FROM AUTHOR]

Background: Treatment selection for squamous cell carcinoma patients aged over 84 years is controversial. This retrospective chart review examined and compared characteristics of laryngeal squamous cell carcinoma in very elderly (over 84 years) and younger patients (approximately 65 years). The secondary objective was to further evaluate the outcome of radiotherapy as a treatment modality in this patient population. Methods: Of all 23 very elderly patients with laryngeal squamous cell carcinoma treated with radiotherapy, with or without surgery, in the Davidoff Cancer Center, from 1992 to 2012, 19 had sufficient data for analysis, and comprised the study group. Results: Median age at diagnosis was 86 years. Disease stage at diagnosis was I, II, III and IVA in 53 per cent, 21 per cent, 21 per cent and 5 per cent, respectively. Median radiotherapy dose was 60 Gy given in 25 fractions. Three patients had recurrence. No patient discontinued treatment because of toxicity. Median overall survival was 3.6 years (range, 0–10 years). Conclusion: Very elderly laryngeal squamous cell carcinoma patients may derive a similar survival advantage as younger counterparts. Modern radiotherapy is effective and safe for treating laryngeal squamous cell carcinoma in this study population. Further, large-scale studies are needed. [ABSTRACT FROM AUTHOR]

Objective: Survival of laryngeal cancer is decreasing; thus, optimal treatment selection is paramount. Specifically, T3 disease survival appears similar with surgical or non-surgical management; however, the implications of vocal cord fixation on treatment selection and survival are unknown. This study seeks to determine if surgical treatment of patients with T3M0 laryngeal cancer with vocal cord fixation is associated with superior survival compared to non-surgical treatment. Methods: The National Cancer Database (NCDB) was queried for all T3M0 laryngeal carcinoma cases from 2004 to 2015, whose treatment included surgery or radiation therapy. Cases were stratified by cord fixation status and overall survival was compared using multivariable methods based on surgical versus non-surgical management. Results: Non-surgical management was more common, regardless of cord fixation status (84% in fixed and 79% in mobile). Cord fixation itself did not influence survival; however, surgical management had a significant survival benefit in the fixed cohort (HR = 0.843; 95% CI: 0.738, 0.962). Conclusion: In this large observational cohort study of T3M0 laryngeal cancer, those with fixed cords had superior survival when managed surgically. [ABSTRACT FROM AUTHOR]

Background: This study aims to compare the performance of intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in treating laryngeal cancer. Method: In this retrospective dosimetric study, 15 patients diagnosed with locally advanced laryngeal cancer (LALC) were selected. The dosimetric performance of the two techniques was analyzed using 6 MV X-rays, based on dose-volume histograms for primary and boost planning target volumes (PTVp and PTVb, respectively), relevant organs at risk (OARs), mean Dose (Dmean), maximum Dose (Dmax), 95% Dose (D95), 2% Dose (D2%), 5% Dose (D5%), monitor units per segment (MU/segment), number of MU/cGy, treatment delivery time, along with conformity and homogeneity indices. Results: Both techniques were able to achieve favorable equivalent uniform doses and low doses to OARs. The average total number of monitor units for IMRT was significantly greater than that for VMAT (1724.5 ± 249.5 and 475.3 ± 47.0, respectively for PTVp and 601.4 ± 81.7 and 458.0 ± 62.6, respectively for PTVb). The modulation factor (MU/cGy) of IMRT was significantly greater than that for VMAT for both the primary and the boost phases. The mean treatment delivery time for all cases of IMRT was significantly longer than that of VMAT. Conclusion: The primary distinction between IMRT and VMAT in the treatment of LALC is that VMAT requires significantly fewer monitor units (one-third) compared with IMRT. This reduction contributes to a decrease in treatment time, which in turn positively impacts patient comfort and the accuracy of treatment. [ABSTRACT FROM AUTHOR]

Objective: To investigate epidemiological, clinical and oncological outcomes of patients with laryngeal verrucous carcinomas (LVC). Methods: Two independent authors investigated PubMed, Scopus and Cochrane Library for studies dedicated to epidemiological, clinical and oncological outcomes of patients with LVC. The following outcomes were investigated with PRISMA criteria: age; gender; tobacco/alcohol consumption; HPV infection; anatomical, pathological, therapeutic and survival outcomes. Studies were analyzed for bias through a validated clinical tool. Results: Of the 212 identified articles, 15 retrospective studies and one prospective uncontrolled study met our inclusion criteria. Three studies reported findings from national databases. The males/females ratio is 9/1. Mean age was 60.3 years, which was younger compared to other laryngeal malignancies. The alcohol, cigarette overuse and the HPV status of patients were lacking in most studies. Glottis and supraglottis were the most common anatomical locations, corresponding to 78.7% and 12.4% of cases, respectively. The main therapeutic approaches consisted of surgery, radiotherapy, surgery followed by radiotherapy. Treatments reported 5-year overall survival and disease-specific survival of 86.3 and 90.8, respectively. The 5- and 10-year local control rate were 83.6 and 72.6, respectively. The 10-year disease-specific survival was 80.2. Heterogeneity between studies was found for inclusion criteria, comorbidity data, and treatments. Conclusion: LVC is a rare laryngeal cancer associated with better survival and recurrence outcomes than laryngeal squamous cell carcinoma. The role of radiotherapy in the treatment regimen needs to be investigated in future prospective controlled studies. [ABSTRACT FROM AUTHOR]

Chronic infectious laryngitis is a clinical mimic of laryngeal carcinoma which can be due to bacterial or fungal aetiology. Both conditions present with non-specific symptoms with leucoplakia on examination. The role of biopsy of laryngeal lesions in the absence of risk factors of laryngeal carcinoma is debatable as it responds to antifungal therapy. This study aimed to review the predisposing factors and role of biopsy in chronic infectious laryngitis. A retrospective review of all cases of chronic infectious laryngitis presented to our centre between 2018 and 2021 were conducted. Clinical features, risk factors, antifungal therapy and its response were reviewed. All cases of chronic infectious laryngitis avoided the need of biopsy while had successful empirical antifungal therapy except for one refractory case. Biopsy of the refractory case was negative for malignancy and the cultureproven Staphylococcus aureus laryngitis was successfully treated with antibiotics. Empirical antifungal therapy in cases of chronic infectious fungal laryngitis with close serial follow-up had good outcome. Biopsy should be reserved for refractory cases to exclude malignancy and guide further antimicrobial therapy. [ABSTRACT FROM AUTHOR]

The article focuses on a case of a 2-month-old male with recurrent stridor, ultimately diagnosed with a left subglottic hemangioma. It discusses the characteristics and diagnosis of infantile subglottic hemangiomas, highlighting the importance of differentiating them from croup, particularly in cases of persistent stridor during viral transmission.

Objectives: Supracricoid partial laryngectomy (SCPL) is an oncologically sound alternative to total laryngectomy that results in long-term alterations in vocal function. Little is known about long-term improvements in dysphonia and the mechanism of vocal recovery is unclear due to the lack of a standardized rating tool: The Pattern, Degree, and Vibration (PDV) Scale. Methods: Data from 24 individuals were compared over 3 post-operative timepoints after SCPL: 3 to 11, 12 to 35, and over 35 months. Voice outcomes were assessed using the Voice Handicap Index (VHI) and the GRBAS scale. Laryngeal exams were deidentified and rated using a novel rating scheme developed using literature review and consensus panel discussions. Results: There were significant improvements in VHI scores, Grade, and Strain over time. There was an increase in the Degree of Closure and a decline in Mucosal Vibration across timepoints. Pattern of Movement (P) was associated with dysphonia Grade. Better Degree of Closure (D) was associated with lower VHI scores and better Grade and Roughness. Mucosal Vibration (V) was associated with reduced Breathiness and Strain but variable Roughness. Age, T-stage, radiation treatment, surgery type, and time to feeding-tube removal were also associated with voicing characteristics. Conclusions: There is evidence of improvement in several voice parameters over time after the first post-operative year. Various subcomponents of the new PDV rating scale were associated with voice outcomes. Its utility for research and clinical practice merits further investigation. [ABSTRACT FROM AUTHOR]

Objective: Laryngeal cancer is the second most prevalent head and neck malignancy in the USA. With recent advances in technology, this procedure is increasingly performed under local anaesthesia. This study aimed to identify the efficacy, safety and cost-effectiveness of laryngeal biopsy in out-patients by conducting a systematic review. Method: A literature search was conducted using PubMed, Medline, Google Scholar and Embase over a 20-year period. Inclusion criteria were: studies performed on out-patient diagnostic biopsy procedures of the larynx. Exclusion criteria included all therapeutic procedures. The outcome measures were sensitivity and specificity, complication rate and cost-savings. Results: Thirty-five studies were included in the analysis. The sensitivity and specificity varied from 60 to 100 per cent with a low complication rate and cost savings. Conclusion: Office-based laryngeal biopsies are increasingly used in the diagnosis of laryngeal cancers, resulting in earlier diagnosis and commencement of treatment. The barrier to undertaking this procedure is low sensitivity. [ABSTRACT FROM AUTHOR]

The current treatment options for T1b glottic carcinoma often lead to poor treatment outcomes or voice quality. This study evaluates the therapeutic efficacy of horizontal middle partial laryngectomy with cricothyroidopexy (HMPL-CTP) for stage T1b glottic carcinoma. A retrospective analysis was conducted on 73 patients with T1b glottic carcinoma. The patients were categorized into three groups: Group A (n = 22) underwent transoral laser microsurgery (TLMS), Group B (n = 21) received frontolateral vertical partial laryngectomy (FVPL), and Group C (n = 30) underwent HMPL-CTP. The study analyzed the 5-year overall survival rate (OS), recurrence rate, phonatory status, and incidence of laryngeal stenosis. Voice quality scores varied significantly in the three groups, while the 5-year OS were similar. The local recurrence rate is higher in Group A than in the other two groups. The laryngeal stenosis rate in Group B is higher than in Groups A and C. Adhesions in the anterior commissure were observed in 18 cases in Group A and nine cases in Group C. HMPL-CTP demonstrates efficacy as a treatment for stage T1b glottic carcinoma, offering favorable preservation of laryngeal function and minimal complications. [ABSTRACT FROM AUTHOR]

Objectives: Metformin is an oral agent used for the management of type 2 diabetes. As a result of its ability to alter cellular metabolic requirements, metformin also possesses antiproliferative properties. Metformin has been shown to reduce mutagenesis in several malignancies, however has never been described as a treatment option for recurrent respiratory papillomatosis (RRP). The aim of this study is to present a case series of non-diabetic patients with adult-onset RRP who were treated with metformin. Methods: Case series. Results: Five patients (age 48 ± 17.82, range 35-68, 4 males, 1 female) were identified with a history of laryngeal RRP who were treated with 500 mg of metformin twice daily. Follow-up time ranged from 11 to 105 months. Two patients had spontaneous regression of RRP lesions within months of starting metformin. Four patients had reduced time intervals between surgical procedures after starting metformin. All patients tolerated metformin well with only minor side effects of self-limiting light-headedness, facial flushing or gastrointestinal upset. Conclusion: Metformin is a low-risk medication that was used to reduce progression and burden of disease in 5 patients with RRP. Further studies should investigate the sole or adjunct use of metformin for treatment of RRP. [ABSTRACT FROM AUTHOR]

Simple Summary: Sarcopenia is characterized by the loss of skeletal muscle mass and function and is common in head and neck oncology. This retrospective study aimed to quantify preoperative muscle mass and quality using CT-based indices and to assess their impact on postoperative outcomes and survival in patients who underwent total laryngectomy for cancer. Based on pre-established cut-off values, 44% of the patients in this series had preoperative skeletal muscle mass depletion. No association was found between CT-based skeletal muscle mass depletion alone and postoperative outcomes or overall survival after total laryngectomy. Purpose: To assess the role of preoperative CT-based skeletal muscle mass depletion on postoperative clinical outcomes and survival in patients who underwent total laryngectomy for cancer. Methods: Patients operated on between January 2011 and March 2020 were retrospectively included. Skeletal muscle area and intra- and inter-muscular fat accumulation were measured at the third lumbar vertebral level on preoperative CT scans. Skeletal muscle mass depletion was defined based on pre-established cut-off values. Their association with postoperative morbidity, length of stay (LOS), costs, and survival was assessed. Results: A total of 84 patients were included, of which 37 (44%) had preoperative skeletal muscle mass depletion. The rate of postoperative fistula (23% vs. 35%, p = 0.348), cutaneous cervical dehiscence (17% vs. 11%, p = 0.629), superficial incisional surgical site infections (SSI) (12% vs. 10%, p = 1.000), and unplanned reoperation (38% vs. 37%, p = 1.000) were comparable between the two patient groups. No difference in median LOS was observed (41 vs. 33 days, p = 0.295), nor in treatment costs (119,976 vs. 109,402 CHF, p = 0.585). The median overall survival was comparable between the two groups (3.43 vs. 4.95 years, p = 0.09). Conclusions: Skeletal muscle mass depletion alone had no significant impact on postoperative clinical outcomes or survival. [ABSTRACT FROM AUTHOR]

Objective: Early detection of hypopharyngeal squamous cell carcinoma (SCC) is important for both an improved prognosis and less-invasive treatment. We retrospectively analyzed the detection rates of early hypopharyngeal SCCs according to the evaluation methods and the clinical management of early hypopharyngeal SCCs. Methods: Sixty-eight patients with early hypopharyngeal SCC who were diagnosed were reviewed. Results: The number of early hypopharyngeal cancer patients with asymptomatic or synchronous or metachronous esophageal cancer examined by upper gastrointestinal endoscopy with narrow-band imaging (NBI) was significantly higher than those examined by laryngopharyngeal endoscopy with NBI. The 3-year disease-specific survival rates according to T classification were as follows: Tis, 100%; T1, 100%; T2, 79.8%; and overall, 91.2%, respectively. Conclusions: Early-stage hypopharyngeal SCC can be cured by minimally invasive transoral surgery or radiotherapy. Observation of the pharynx using NBI in patients with a history of head and neck cancer, esophageal cancer, gastric cancer, or pharyngeal discomfort is very important, and routinely examining the pharynx with NBI, even in patients undergoing endoscopy for screening purposes, is recommended. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the long-term functional outcomes in patients who received primary radiotherapy for tumour–node stage T2N0 glottic carcinoma, stratified for tumour extension. Methods: A cross-sectional study was performed on patients who were treated with radiotherapy for T2N0 glottic carcinoma. Four questionnaires were used to measure different aspects of functional outcome. In addition, objective evaluation and perceptual analysis were performed. Results: Fourteen patients were included in this study. The median time between the start of radiotherapy and assessment was 42 months (range, 26–143 months). Patients reported high-level functioning, with low symptom scores and good swallowing function, and showed a median dysphonia grade of 1.5. The median Voice Handicap Index-30 score was 17.5. Conclusion: Patients with T2N0 glottic carcinoma treated with radiotherapy had good long-term quality of life, with low symptom scores, good swallowing functioning and slightly elevated voice outcome parameters. [ABSTRACT FROM AUTHOR]

Background: For recurrent laryngeal cancer, the feasibility of salvage transoral laser microsurgery (TLM) remains controversial. This study compared the efficacy of TLM and open partial laryngectomy (OPL) for treatment of early local recurrence of glottic squamous cell cancer (GSCC) and confirm the effectiveness of salvage TLM as a treatment option. Methods: This retrospective study involved 55 patients with early local recurrent GSCC treated with TLM, and the oncologic outcomes, functional outcomes, hospitalization time and complications were compared with a group of 40 recurrent GSCC patients matched for clinical variables of TLM group, treated by OPL by the same team of surgeons. Results: The 5-year overall survival and disease-specific survival rates were 65.8% and 91.5%, respectively, for 55 patients with rTis–rT2 stage treated by TLM and 77.1% and 94.7%, respectively, for 40 patients with rTis–rT2 stage treated by OPL (OPL group). In the TLM and OPL groups, the local control rates after 5 years were 77.5% and 79.3%, respectively, and the laryngeal preservation rates were 94.4% and 83.6%, respectively (p > 0.05). Compared with the OPL group, the complication rate (1.82%) and hospitalization duration (5.42 ± 2.26 days) were significantly lower in the TLM group (p < 0.05). Compared with the OPL group, postsurgical health-related quality of life and quality of voice were significantly better in the TLM group (p < 0.001). Conclusion: Salvage TLM can be used as an effective treatment option for suitable patients after a full, comprehensive, and careful assessment of the characteristics of early locally recurrent glottic carcinoma. [ABSTRACT FROM AUTHOR]

Simple Summary: The results of this large series highlight the good onco-functional results of selected pT4a laryngeal tumors treated with open partial horizontal laryngectomies (OPHL). The best cases to be treated with OPHLs are the low-volume pT4a laryngeal tumors, with minimal or absent cartilage destruction. The level of standardization of these procedures' indications should allow consideration of open partial horizontal laryngectomy as a valid therapeutic option in case of a patient's absolute refusal of total laryngectomy or non-surgical protocols with concomitant chemo-radiotherapy. Based also on the obtained results in the treatment of selected pT4a, such a surgical strategy should no longer be considered anecdotal. Extending the limit of resection and including a large part of the cricoid cartilage and one crico-arytenoid unit (type III OPHL + CAU) expanded the indications of type II OPHL + ARY, allowing for a safer resection of advanced and challenging laryngeal tumors. A large multi-institutional case series of laryngeal cancer (LC) T4a was carried out, including 134 cases treated with open partial horizontal laryngectomies (OPHL) +/− post-operative radiation therapy (PORT). The goal was to understand better whether OPHL can be included among the viable options in selected pT4a LC patients who refuse a standard approach, represented by total laryngectomy (TL) + PORT. All 134 patients underwent OPHL type I (supraglottic), II (supracricoid), or III (supratracheal), according to the European Laryngological Society Classification. Comparing clinical and pathological stages showed pT up-staging in 105 cases (78.4%) and pN up-staging in 19 patients (11.4%). Five-year data on overall survival, disease-specific survival, disease-free survival, freedom from laryngectomy, and laryngo-esophageal dysfunction-free survival (rate of patients surviving without a local recurrence or requiring total laryngectomy and without a feeding tube or a tracheostomy) were, respectively, 82.1%, 89.8%, 75.7%, 89.7%, and 78.3%. Overall, complications were observed in 22 cases (16.4%). Sequelae were observed in 28 patients (20.9%). No patients died during the postoperative period. This large series highlights the good onco-functional results of low-volume pT4a laryngeal tumors, with minimal or absent cartilage destruction, treated with OPHLs. The level of standardization of the indication for OPHL should allow consideration of OPHL as a valid therapeutic option in cases where the patient refuses total laryngectomy or non-surgical protocols with concomitant chemo-radiotherapy. [ABSTRACT FROM AUTHOR]

Objectives: Hypopharyngeal and laryngeal cancers are aggressive and usually diagnosed at advanced stage with esophagus invasion. Total pharyngolaryngoesophagectomy with gastric pull-up reconstruction has been a common surgery for these cancers but long-term outcomes are still questionable. This study aimed to investigate short-term and long-term outcomes of patients who underwent this surgery. Methods: Patients with hypopharyngeal or laryngeal cancer invading cervical esophagus who underwent total pharyngolaryngoesphagectomy with gastric pull-up between 2012 and 2016 was included and followed up until 2021. Short-term outcomes were complications and long-term outcomes were overall survival (OS) and disease-free survival (DFS). Results: Fifty patients were included with a mean age of 60.3 years and 94% were male. Pyriform fossa was the most common primary site of tumor (50%), followed by posterior hypopharyngeal wall (18%) and postcricoid region (18%). Mean operating time, postoperative oral intake and hospital stay was 363.1 ± 43.6 minutes, 8.8 ± 3.6 days and 14.2 ± 3.0 days respectively. Complications occurred in 15 patients (30%) without any in-hospital death. During the follow-up period, 17 patients had recurrence and 35 patients died. Median (95% confidence interval [CI]) OS and DFS time were 30 (21-37) and 30 (19-36) months. Five-year OS and DFS probability (95% CI) were 22.6% (12.8-39.7) and 22.7% (12.9-39.8). Conclusions: Total pharyngolaryngoesophagectomy with gastric pull-up is feasible and safe. However, even with curative surgery and multimodal treatment, advanced pharyngeal or laryngeal cancer with cervical esophagus invasion still has poor survival outcome. [ABSTRACT FROM AUTHOR]

T2N0M0 glottic laryngeal squamous cell carcinoma (LSCC) is a common type of laryngeal cancer. The objective of this research was to assess the predictive value of tumor size for the rates of overall survival (OS) and disease-free survival (DFS) as determined by postoperative pathological examination in patients with T2 LSCC. A retrospective study was conducted on 535 successive patients with T2 glottic LSCC who underwent operation from 2005 to 2010. The effect of tumor size on OS and DFS results was evaluated by the affected area. Of the cohort, 528 (98.7%) were male, and 7 (1.3%) were female, with an average age of 60.1 ± 9.4 years. The 10-year DFS and OS rates were 72.1% and 76.3%, respectively. The tumor diameter and area cut-off values that best discriminated OS and DFS rates were 1.35 cm and 1 cm2, respectively. Patients with glottis carcinoma with a longer tumor diameter and larger tumor area had inferior OS and DFS rates. Tumor diameter and tumor area were independent predictive factors for the rates of OS and DFS in patients with T2 glottic LSCC. This research showed that patients with T2 glottic LSCC with a carcinoma diameter >1.35 cm or a tumor area >1 cm2 have worse survival outcomes. These factors independently predict survival outcomes in patients. [ABSTRACT FROM AUTHOR]

Simple Summary: The management of close and/or positive margins after transoral CO2 laser microsurgery (CO2 TOLMS) is still an ongoing matter of discussion. Different options have been suggested on the basis of the number of the involved margins (single vs. multiple) and site (deep vs. superficial): strict follow-up, revision surgery or radiotherapy. However, precise indications about additional treatment and its effective impact on local control and survival rates are still lacking. The authors reviewed 351 patients with early glottic cancer treated using CO2 TOLMS with the aim of analyzing the impact of margin status on local control and survival, and discussing the therapeutic options in cases of close and positive margins. Background: The present study analyzed the impact of margin status on local control and survival, and the management of close/positive margins after transoral CO2 laser microsurgery for early glottic carcinoma. Methods: 351 patients (328 males, 23 females, mean age 65.6 years) underwent surgery. We identified the following margin statuses: negative, close superficial (CS), close deep (CD), positive single superficial (SS), positive multiple superficial (MS), and positive deep (DEEP). Results: A total of 286 patients (81.5%) had negative margins, 23 (6.5%) had close margins (8 CS, 15 CD) and 42 (12%) had positive margins (16 SS, 9 MS, 17 DEEP). Among the 65 patients with close/positive margins, 44 patients underwent enlargement, 6 radiotherapy and 15 follow-up. Twenty-two patients (6.3%) recurred. Patients with DEEP or CD margins showed a higher risk of recurrence (hazard ratios of 2.863 and 2.537, respectively), compared to patients with negative margins. Local control with laser alone, overall laryngeal preservation and disease-specific survival decreased significantly in patients with DEEP margins (57.5%, 86.9% and 92.9%, p < 0.05). Conclusions: Patients with CS or SS margins could be safely submitted to follow-up. In the case of CD and MS margins, any additional treatment should be discussed with the patient. In the case of DEEP margin, additional treatment is always recommended. [ABSTRACT FROM AUTHOR]

Introduction: We compare long-term voice outcomes in patients treated with European Laryngeal Society (ELS) classification Type I, Type II, or Type V cordectomy. The aim is to understand the impact of Type V cordectomy on voice outcomes in relation to Type I and Type II cordectomy. Methods: A retrospective review of patients treated with Type I, Type II, or Type V cordectomy by a single surgeon over a 20-year period was performed. Voice Handicap Index-10 (VHI-10) scores, Cepstral Spectral Index of Dysphonia (CSID) measures from CAPE-V sentences, and two-rater GRBAS scores were analyzed. Results: Sixty-two patients were identified with a mean follow-up of 52 months. Of these, there were 43 Type I and 19 Type II cordectomies, including 8 in each group with Type V resections. Significant differences in all parameters were noted between the Type I (VHI 5.7, CSID 20.6, Grade 1.3) and the Type II cohorts (VHI 12.6, CSID 36.3, Grade 1.8) who did not undergo Type V cordectomy. Patients undergoing Type V cordectomy demonstrated voice outcomes (VHI 9.4, CSID 35.6, Grade 1.7) which fell between those of Type I and Type II cordectomies. Conclusions: Better long-term subjective, objective, and computer-analyzed voice outcomes are noted for patients undergoing Type I rather than Type II cordectomy. When Type V cordectomy is performed, voice outcomes are comparable to those of both Type I and Type II cordectomy, a surprising finding given the expectation of worsened dysphonia in longer resections. Further work is needed to explain this finding and define voice outcomes after Type V cordectomy. [ABSTRACT FROM AUTHOR]

Background: Laryngeal cancer accounts for 1% of all cancers in men and 0.3% of all cancers in women. Pharyngolaryngectomy (TPL) and total laryngectomy (TL) are central surgical techniques in the management of advanced laryngeal malignancies but are associated with significant morbidity. In addition, optimal reconstruction following TPL remains an area of active research. Methods: Here, we compared speech and swallowing outcomes following circumferential and partial pharyngeal resection alongside total laryngectomy in patients with laryngeal and hypolaryngeal tumors. We performed a systemic analysis of patient demographics, tumor characteristics, treatment modality, and pharyngeal reconstruction technique following TPL and TL, leveraging data collected over a 20-year period at a large tertiary referral center. Results: Analyzing 155 patients the results show circumferential pharyngeal defects and prior radiotherapy have a significant impact on surgical complications. Conclusion: Pharyngeal resection carries a substantial risk of incurring impaired speech and swallowing in patients. Moreover, our results support poorer functional outcomes with more radical pharyngeal resections and show a clear trend toward worse swallowing outcomes in salvage surgery. [ABSTRACT FROM AUTHOR]

Objectives: Discussions regarding the specific management and outcomes for laryngeal MEC are limited to very small, single-institution case series. To look further into the diagnosis and management of these uncommon non-squamous cell carcinomas of the larynx, we present 3 recent cases of laryngeal MEC treated at our institution. Methods: Patients at a tertiary hospital treated for MEC between October 2019 and December 2020 were retrospectively identified. Chart review, imaging analysis, and histologic slide creation were completed for all patients. Results: We identified and treated 2 patients with high-grade supraglottic and 1 patient with intermediate-grade glottic MEC. These patients presented to our clinic with a primary complaint of either gradual, worsening dysphonia, dysphagia, or both. All patients underwent laryngovideostroboscopy as well as panendoscopy with directed submucosal biopsy, which was consistent with MEC. MRI was performed in 2 of the cases further elucidating the extent of submucosal spread. PET-CT was performed in all 3 cases, and none demonstrated evidence of regional or distal metastases. Surgically, high-grade MEC lesions were treated with a total laryngectomy. The intermediate MEC lesion was managed with a supracricoid partial laryngectomy (SCPL). Surgical margins were free of tumor in all cases with no nodal metastases by modified radical neck dissection. Radiation therapy was offered to both high-grade MEC patients and declined by one. Radiation was not recommended to the patient with intermediate-grade MEC as we believed that the risk of additional treatment outweighed the benefit. Conclusion: We believe that MEC of the larynx should be considered in patients with atypical submucosal laryngeal masses. Laryngovideostroboscopy, MRI, and PET imaging may be valuable in determining the extent of the lesions and planning appropriate surgery. Postoperative radiation therapy should be considered a per tumor grade in other more studied sites, as there is no data on efficacy in laryngeal MEC. [ABSTRACT FROM AUTHOR]

Objective: Surgery is the recommended treatment for resectable T4a laryngeal and hypopharyngeal carcinoma. Non-surgical treatment is an option in a select few patients. Method: This retrospective study was undertaken to assess the treatment outcomes in patients with resectable T4a carcinoma of the larynx and hypopharynx who received either surgical or non-surgical treatment at our institute and to assess factors influencing these outcomes. Results: A total of 120 patients were included in the study. They were divided into groups A, B and C based on the presence of extralaryngeal spread through laryngeal membrane, cartilage or both. The overall survival was better among patients who received surgery than those who received non-surgical treatment in the three groups. The factor influencing overall survival was the treatment given in the form of surgical versus non-surgical treatment. Conclusion: Surgery is the preferred treatment for T4a laryngeal and hypopharyngeal carcinoma, even in patients with extralaryngeal spread without cartilage erosion. [ABSTRACT FROM AUTHOR]

Objective: Current evidence suggests there is no difference between endoscopic laser surgery and radiotherapy with regards to oncological outcomes of early laryngeal cancer. Patient management may therefore be directed towards voice and quality of life outcomes. This systematic review compares functional outcomes with respect to voice character, swallowing outcomes and quality of life for endoscopic laser surgery versus radiotherapy for T1 and T2 stage laryngeal carcinoma. Method: Search terminology was designed by both authors and used in Cochrane, PubMed and Web of Science databases. Studies of adult patients treated for primary T1 and T2 laryngeal squamous cell carcinoma utilising one objective (validated) measure of quality of life, swallowing or voice were included. Results: Initial searches identified 1767 studies. After inclusion and exclusion criteria were applied, 42 studies were identified for full-text review. Conclusion: This review concluded that neither treatment is clearly advantageous. Future research should be composed of further prospective studies that use a standardised assessment regime to allow valid comparison. [ABSTRACT FROM AUTHOR]

Background. Cisplatin resistance is observed in patients with laryngeal cancer. The present study was designed to explore the efficacy of oxaliplatin on laryngeal cancer and elucidate the underlying mechanisms. Methods. Cell viability was determined by using MTT assays. Cell apoptosis was determined by using annexin V and propidium iodide (PI) staining. Flow cytometry and immunofluorescence were applied to determine the levels of calreticulin (CALR) and DiD (1,1-dioctadecyl-3,3,3,3-tetramethylindodicarbocyanine). Flow cytometry was applied to analyze the levels of CD83, CD86, IFN-γ-producing CD8+ T cells, and CD4+CD25+FoxP3+ Tregs. The levels of adenosine triphosphate (ATP) were determined by using a chemiluminescent ATP kit and cytokines were determined by using specific enzyme-linked immunosorbent assays (ELISAs). The levels of HMGB1 were determined by using Western blot and ELISA, respectively. The xenograft animal model was constructed to evaluate the antitumor effects of oxaliplatin. Results. Oxaliplatin inhibited cell growth, promoted cell apoptosis, and induced the levels of CALR, ATP, and high mobility group box protein 1 (HMGB1) in Hep-2 cells. Oxaliplatin-treated Hep-2 cells increased the intensity of DiD and the levels of CD83 and CD86 in dendritic cells (DCs), as well as induced the supernatant IL-6 and TNF-α. Oxaliplatin-treated primary laryngeal cancer cell-pulsed DCs increased the IFN-γ-producing CD8+ T cells and suppressed CD4+CD25+FoxP3+ Tregs. In vivo data showed that oxaliplatin suppressed tumor growth and increased the populations of CD86+CD80+ and CD8+CD45+ cells in the tumor tissues. Conclusion. Treatment with oxaliplatin inhibited laryngeal cancer cells by inducing immunogenic cell death. [ABSTRACT FROM AUTHOR]

Carotid artery involvement in head and neck cancer is challenging for surgeons and oncologists, particularly in recurrence or residual disease following multiple treatments. However, carotid artery resection and reconstruction can be safely performed in a carefully selected patient with local and regional control benefits despite the potential morbidity and high-risk complications. We presented a case of primary laryngeal cancer treated with chemoradiotherapy, modified radical neck dissection type I for residual neck node disease, and further chemotherapy. Although the primary laryngeal cancer showed a complete response, the residual neck tumor was still unresolved and even involved the carotid artery. Therefore, carotid resection with a combined saphenous vein graft and free flap reconstruction was the treatment of choice for this patient. It is effective and safe, and the risk of morbidity has been accepted. [ABSTRACT FROM AUTHOR]

Simple Summary: Head and neck squamous cell carcinoma (HNSCC) incidence has been escalating in the last two decades, particularly in Western Europe and North America. Human papillomavirus (HPV) has been identified as the main culprit for this rise with significant implications for the treatment and outcomes of these patients. The purpose of this retrospective study was to investigate HPV's impact on HNSCC patient outcomes in the Irish population, which has never been performed before. HPV positivity of HNSCC appears to be associated with improved survival in patients and highlights the importance of surgery, perhaps with less severe chemo-radiation therapy, in HPV-related HNSCC treatment. Human papillomavirus (HPV) infection has been identified as a significant etiological agent in the development of head and neck squamous cell carcinoma (HNSCC). HPV's involvement has alluded to better survival and prognosis in patients and suggests that different treatment strategies may be appropriate for them. Only some data on the epidemiology of HPV infection in the oropharyngeal, oral cavity, and laryngeal SCC exists in Europe. Thus, this study was carried out to investigate HPV's impact on HNSCC patient outcomes in the Irish population, one of the largest studies of its kind using consistent HPV testing techniques. A total of 861 primary oropharyngeal, oral cavity, and laryngeal SCC (OPSCC, OSCC, LSCC) cases diagnosed between 1994 and 2013, identified through the National Cancer Registry of Ireland (NCRI), were obtained from hospitals across Ireland and tested for HPV DNA using Multiplex PCR Luminex technology based in and sanctioned by the International Agency for Research on Cancer (IARC). Both overall and cancer-specific survival were significantly improved amongst all HPV-positive patients together, though HPV status was only a significant predictor of survival in the oropharynx. Amongst HPV-positive patients in the oropharynx, surgery alone was associated with prolonged survival, alluding to the potential for de-escalation of treatment in HPV-related OPSCC in particular. Cumulatively, these findings highlight the need for continued investigation into treatment pathways for HPV-related OPSCC, the relevance of introducing boys into national HPV vaccination programs, and the relevance of the nona-valent Gardasil-9 vaccine to HNSCC prevention. [ABSTRACT FROM AUTHOR]

Objectives: Selective radiotherapy and concomitant intra-arterial cisplatin infusion (m-RADPLAT) with a lower cisplatin dosage have been performed for organ and function preservation in patients with locally advanced squamous cell carcinoma of the larynx (SCC-L), and results showing a lower rate of adverse events have been reported. This study evaluated the treatment outcomes of patients with T3N0 glottic SCC-L with or without vocal fold fixation (VFF) who were treated with m-RADPLAT. Methods: We retrospectively reviewed the data of 33 patients with T3N0 SCC-L who received m-RADPLAT. Results: The vocal fold in patients with VFF 3 months after completing m-RADPLAT resumed normal movement in 15 patients (83%) and persisted fixation in 3 (17%). The 3-year local control, laryngeal cancer-specific survival, and overall survival rates of patients with or without VFF were 88.9% and 86.7%, 94.1% and 93.3%, and 88.9% and 86.7%, respectively. Additionally, the 3-year freedom from laryngectomy, laryngectomy-free survival, and laryngo-esophageal dysfunction-free survival rates of patients with or without VFF were 94.4% and 86.7%, 88.9% and 73.3%, and 83.3% and 73.3%, respectively. Grade 3 or higher toxicities were observed in all patients: leukopenia in 4 patients (12%), neutropenia in 5 (15%), anemia in 2 (6%), thrombocytopenia in 3 (9%), and mucositis in 2 (6%). Conclusions: This study demonstrated that m-RADPLAT yielded VFF improvement and a favorable survival while maintaining laryngeal function not only in patients with T3N0 glottic SCC-L without VFF but also in patients with VFF. [ABSTRACT FROM AUTHOR]

Chemoradiation therapy is standard practice for hypopharyngeal and laryngeal cancer, but its impact on skin health can cause complications if salvage surgery is required. To develop simple objective indices for the early detection of complications following head-and-neck salvage surgery. Preoperatively and on postoperative days 1, 3, 5 and 7, we measured skin hardness (N), interstitial liquid content (П) and intracellular liquid content (W) as biophysical properties in patients who underwent post-CRT salvage therapy and those who underwent total organ resection without CRT as controls. We then analyzed these data in relation to occurrence of complications. In 11 patients undergoing salvage surgery and 23 controls, complications tended to be higher (p =.54) in the salvage group. N values were significantly higher in the salvage and complication groups on days 5 and 7, П values were higher in the complication group on day 7, and W values were lower in the complication group on day 3 and in the salvage group preoperatively and on days 1 and 5. N, П and W are useful measurements for the early identification of patients likely to develop complications. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma (SCC) of the vocal cord in stages I or II can be treated with radiotherapy (RT) or transoral CO2 laser microsurgery (TLM), with good oncological results. To study the survival of patients with SCC of the vocal cord in early stages, treated with RT or TLM, in a tertiary hospital. Disease-free survival (DFS), specific survival (SS), and overall survival (OS) were studied in patients diagnosed with stage I and II SCC of the vocal cord, for a span of 10 years of follow-up, based on sociodemographic characteristics of the patient and the primary treatment (TLM or RT). Both treatments achieved good survival rates. However, long-term SS was greater in patients treated with TLM compared to those treated with RT (91.7% vs. 50%, respectively, p =.001). In addition, patients treated with TLM presented a higher OS in the short term than those treated with RT (99.0% vs. 89.1%, respectively. p =.004). Primary treatment with TLM obtained better results than RT in the survival of patients with SCC of the vocal cord in the early stages. [ABSTRACT FROM AUTHOR]

Background: Tracheoesophageal puncture (TEP) with use of a prosthesis is nowadays a standard for voice restoration after laryngectomy. Different TEP approaches exist. Methods: We retrospectively reviewed our series of patients who underwent TEP by a novel technique, based partially on the Lichtenberger endo-extralaryngeal needle carrier. The instrument is covered with a protective Nelaton catheter and introduced via the mouth to the neopharynx/esophagus. No rigid endoscope is used for visualization of the TEP site. The tip is palpated through the stoma at the posterior tracheal wall and incision is done to the catheter tip. The prosthesis is introduced through the mouth and the neopharynx in a retrograde fashion. Results: In 14 laryngectomees with postoperative radiation voice prosthesis was successfully placed with this technique. A total of 18 procedures were performed. One misplacement occurred. No other early or late complications were observed or any other TEP or prosthesis related problems. Conclusions: The rationale of our technique is to simplify the procedure, avoid risk-bearing approaches and instruments such as rigid endoscopes, simplify the armamentarium and reduce tissue trauma. The initial clinical experience in 18 TEPs confirmed it usefulness in both standard and anatomically challenging situations. Trial registration: The current study obtained the ethical approval from the Faculty of Medicine at Medical University "Prof. Dr. Paraskev Stoyanov"—Varna, Bulgaria (Protocol 087/24.10.2019 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Objective: Laryngeal squamous cell carcinoma has a high mortality rate, and approximately 60% of patients are in advanced stage at the time of diagnosis. Thus, determining the prognostic parameters of this cancer and markers related to these parameters are very important. There are studies showing that heat shock-related 70-kDa protein 2, which is used as a biomarker, may be associated with prognostic parameter in some cancers. However, no study has investigated the prognostic role of heat shock-related 70-kDa protein 2 in laryngeal squamous cell carcinoma in the literature. Thus, in our study, the aim was to examine the relationship between heat shock-related 70-kDa protein 2 expression and clinicopathological prognostic parameters in laryngeal squamous cell carcinoma. Materials and Methods: Our study included 104 patients diagnosed with laryngeal squamous cell carcinoma between January 2005 and January 2016. The correlation between heat shock-related 70-kDa protein 2 expression and prognostic parameters was investigated by using the immunohistochemical method with heat shock-related 70-kDa protein 2 antibody. Results: In all the cases, heat shock-related 70-kDa protein 2 positivity was determined in tumoral areas (100%). The overexpression rate of heat shock-related 70-kDa protein 2 in adjacent non-cancerous tissues with dysplasia was 48/104 (42%) (P < .0001). A significant relationship was found between heat shock-related 70-kDa protein 2 expression and important prognostic parameters such as macroscopic tumor size, lymphovascular invasion, primary tumor, lymph node metastasis, distant organ metastasis, tumor, node, metastasis (TNM) stage stage, recurrence, and survival rates (P < .05). Conclusion: Our study supports the presence of an association between high heat shock-related 70-kDa protein 2 expression levels and prognostic parameters in laryngeal squamous cell carcinoma. We consider that heat shock-related 70-kDa protein 2 can be used as a prognostic marker in laryngeal squamous cell carcinoma. In addition, it may be important in early diagnosis due to its increased expression even under laryngeal squamous cell carcinoma precursor conditions. [ABSTRACT FROM AUTHOR]

Simple Summary: The present study has been suggested by the previous experience of our group showing that patients treated with conventional radiotherapy (named 3D conformal radiotherapy—3D-CRT) performed after conservative surgery (CS) for tumors of the supraglottic regions experienced a high rate of severe long-term toxicity. Therefore, we reported the toxicity profile of a similar cohort of patients treated with a high-precision radiotherapy technique (named intensity-modulated radiotherapy—IMRT). Moreover, to investigate the advantage of IMRT, we performed a comparison with a historical cohort treated with 3D-CRT. Results showed that patients treated with IMRT achieved a very low toxicity profile and comparison with 3D-CRT was in favor of IMRTs. Therefore, we believe that the results of the present study provide preliminary findings on the potential of IMRT in improving the toxicity profile of patients treated with surgical organ preservation strategies for laryngeal tumors. The aim of the present study was to investigate the role of intensity-modulated radiotherapy (IMRT) on the toxicity profile of patients treated with conservative surgery (CS) of the supraglottic (SG) region. Data on patients treated with CS and postoperative radiotherapy (PORT)-IMRT were prospectively collected. Results. In total, 20 patients were analyzed. Of these, six patients (35%) required the positioning of a temporary tracheostomy. The functional larynx preservation rate was 95%. Females had a higher risk of both endoscopic intervention and chondronecrosis, while the median age was significantly higher in patients requiring enteral nutrition. The incidence of long-term severe toxicities was lower in patients treated with IMRT than in the historical 3D-CRT cohort. Patients who had received PORT-IMRT achieved a lower rate of permanent laryngeal and swallowing dysfunctions. Overall, results from the comparison with the historical 3D-CRT cohort favor the IMRTs. [ABSTRACT FROM AUTHOR]

Background: Anti-PD1-Checkpoint inhibition (CI) is an established treatment of recurrent and/or metastatic head and neck cancer. A potential benefit from CI in early-stage disease that is usually treated by radiation or surgery has not been investigated so far and is currently not addressed in clinical trials. Case presentation: A 58-year-old man was diagnosed with a cT2 supraglottic laryngeal cancer and a synchronous metastasized adenocarcinoma of the lung. As the patient refused any treatment of his laryngeal cancer, he received combined immune-chemotherapy according to the KEYNOTE-189 protocol. After 4 cycles of pembrolizumab/carboplatin/pemetrexed, the patient showed a complete remission of his laryngeal cancer with a clear shrinkage of the mediastinal and hilar lung cancer metastases. After 21 cycles of maintenance therapy, the lung adenocarcinoma shows a stable disease status with no signs of any residual or recurrent laryngeal cancer. Conclusions: Anti-PD1-CI may be a treatment option also for early-stage HNSCC with excellent functional outcome when established therapies are not available. [ABSTRACT FROM AUTHOR]

Purpose: The prognosis of glottic T1a laryngeal squamous cell carcinoma (LSCC) is excellent with both transoral laser surgery (TLS) and radiation therapy (RT). Our aim was to compare TLS and RT treatment results in a randomized study.Methods and Materials: Of 56 male patients with glottic T1a LSCC, 31 were randomized for TLS and 25 for RT. Survival and larynx preservation data were collected from medical records.Results: Five-year overall survival (OS) was 87%, disease-specific survival (DSS) was 97%, and recurrence-free survival (RFS) was 81% in patients treated with TLS. Five-year OS was 92%, DSS was 100%, and RFS was 88% in patients treated with RT. The primary treatment method was not associated with OS, RFS, or DSS in a log-rank test. The larynx preservation rate was similar in both groups (TLS, 97%; RT, 92%; P = .575).Conclusions: In a prospective randomized setting oncological outcomes of both treatment modalities (TLS or RT) for T1a LSCC were similar. [ABSTRACT FROM AUTHOR]

Digital modeling and three-dimensional (3D) printing techniques have been used to assist the resection of the laryngeal lesions and repair the remnant larynx in glottic cancer patients with anterior commissure involvement. To evaluate the feasibility of digital modeling and 3D printing of titanium mesh for thyroid cartilage reconstruction in partial laryngectomy, and compare the advantages and disadvantages with crico-hyoido-epiglottopexy (CHEP). Forty-four glottic cancer patients with anterior commissure involvement were randomly assigned into group A and group B. The digital modeling and 3 D printing were used for patients in group A, and patients in group B underwent the modified CHEP. In group A, 10 patients underwent tracheotomy and tracheal tube was removed after 2 weeks. All the patients were discharged within 10 d after surgery, and the majority of them had a satisfactory level of pronunciation. In group B, the majority of the patients were discharged 2 − 3 weeks after surgery with a moderate level of pronunciation. The proposed surgical method, employing digital modeling and 3D printing to facilitate resection of laryngeal lesions and reconstruction of residual larynx, exhibited to be beneficial for accurate reconstruction of thyroid cartilage and soft tissues. [ABSTRACT FROM AUTHOR]

This study aims to report on the effectiveness of voice rehabilitation following radiotherapy for laryngeal cancer in a long-term perspective, i.e., up to three years after completion of radiotherapy. The study included a total of 74 patients that were randomised into an intervention group (n = 37) or a control group (n = 37). Voice recordings with blinded assessment of voice quality with the GRBAS protocol (Grade, Roughness, Breathiness, Asthenia, Strain) and acoustic analysis was performed at baseline, 12 and 36 months following radiotherapy. Voice rehabilitation was performed in 10 sessions immediately following completion of radiotherapy. Patients also filled out the Swedish Self-Evaluation of Communication Experiences after Laryngeal cancer. The S-SECEL demonstrated statistically significant improvements in the intervention group when comparing baseline and 36 months, and no changes in the control group. Acoustic measures did not reveal any significant changes. The perceptual analysis demonstrated that when comparing the changes within the groups between baseline and 36 months there were statistically significant differences between the intervention and control group regarding the voice qualities Roughness, Breathiness and Strain. In the control group, 50% demonstrated deterioration in roughness, while in the intervention group only 7% deteriorated during this time. In Breathiness and Strain, 57 and 50%, respectively, improved in the intervention group, while only 32% and 23% improved, respectively, in the control group. Voice rehabilitation following radiotherapy for laryngeal cancer demonstrate positive effects in patient reported outcomes and perceptual measures of voice quality, and the effects remain up to three years following radiotherapy. [ABSTRACT FROM AUTHOR]

Background: This paper reports a case of chondrosarcoma deriving from the left arytenoid cartilage that was resected via an anterior laryngofissure using the Tritube in situ, thus eliminating the need for a (temporary) tracheostomy. Case report: A 49-year-old male with a chondrosarcoma deriving from the left arytenoid was treated with local resection of the tumour through an anterior laryngofissure. The intralaryngeal lumen was too small for a normal endotracheal tube. Using the Tritube (outer diameter, 4.4 mm), the patient could be intubated and ventilated adequately during the procedure. The Tritube did not obstruct the surgical view during the procedure. Conclusion: The Tritube can be used for intubation and ventilation even in patients with a very narrow airway lumen, and does not obstruct the field of view during open laryngeal surgery, thereby avoiding the need for peri-operative tracheostomy. [ABSTRACT FROM AUTHOR]

Background: Laryngeal cancers of glottic origin comprise a large proportion of head and neck malignancies. Transoral laser microsurgery (TLM) and radiation therapy are mainstays in the treatment of early stage glottic cancer, but debate persists as to which modality is functionally superior. Furthermore, there is a paucity of North American data related to functional and oncological outcomes in T1a glottic cancer. Here, we assessed oncological and functional outcomes of T1a glottic squamous cell carcinoma (SCC) with TLM to supplement evidence from jurisdictions outside North America. Methods: This study is a retrospective cohort study performed from a prospectively collected tertiary center institutional TLM database. Patients who were diagnosed with T1a glottic SCC and underwent TLM as their primary treatment were included. Functional outcomes were analyzed using the Voice Handicap Index-10 (VHI-10) questionnaire. Ultimate control with TLM only was considered to be those patients with locoregional control with repeat TLM procedures, but without addition of other modalities. Student's t-test was used to test significance and Kaplan–Meier survival analysis was used to assess oncological outcomes. Results: 48 patients met study criteria. The mean follow-up time was 74 months. The 5-year locoregional, ultimate control with TLM only and laryngeal preservation rates were 83.2%, 90.4% and 100%, respectively. The overall survival and disease-specific survival were 87.2% and 100%, respectively. VHI-10 scores were available for 13/48 patients and mean scores improved non-significantly from pre-op (mean: 11.23; range: 2 to 30; median: 10) and post op (mean: 7.92; range: 0 to 18; median: 8) scoring (p-value = 0.15). Sub-stratification of voice data revealed a significant improvement between pre and post-operative scores (mean difference − 10.6, 95% CI: − 0.99 to − 20.21, p-value = 0.035) for patients with abnormal pre-operative scores (VHI > 11). Conclusion: To our knowledge, the current work represents one of the first North American studies to report both functional and oncologic outcomes for TLM treatment of T1a glottic SCC. The oncologic and functional outcomes presented here add to existing evidence in favor of TLM as a safe and effective primary treatment option for early staged T1a glottic cancer. [ABSTRACT FROM AUTHOR]

Introduction: UK population ageing and associated cancer risk predicts an increase in the prevalence of laryngeal cancer in elderly patients. Whilst trans-oral laser microsurgery (TLM) has been demonstrated to achieve excellent control of early disease with few complications, data specifically related to its safety and efficacy in older patients is lacking. We report the largest series to date. Objectives: To assess the safety and efficacy of TLM in elderly patients with glottic pre-malignancy and early malignancy. Methods: A retrospective review and statistical analysis of the clinical records of patients aged 70 or over undergoing TLM for early and premalignant glottic disease. Results: The records of 106 patients over the age of 70 were identified. Thirteen records were excluded, 4 due to failure to meet the inclusion criteria (stage I/II disease, primary site of lesion in the glottis) and 9 due to incomplete follow up data capture. Most surgeries (>70%) were performed as a day case or overnight admission, with only 2 admissions >2 days. One patient required hospital readmission with dysphagia, resulting in an altered diet. No patients required tracheostomy or tube feeding. No treatment related deaths or intensive care admissions were observed. Ten patients had recurrent disease within 5 years; 1 received radiotherapy, 1 underwent salvage laryngectomy, the remainder had further TLM without complication. Five-year disease specific survival rates were >90%. Conclusion: Our results demonstrate that TLM is safe and effective for elderly patients, with outcomes comparable to those reported in large, non-age selected cohorts. Although our patients underwent more conservative cordectomy types (I-III) than those with similar disease stages reported elsewhere, our recurrence rates were not higher. This supports the oncological effectiveness of surgery whilst reducing the risk of associated functional compromise. [ABSTRACT FROM AUTHOR]

Extramedullary plasmacytoma (EMP) is a malignant tumor formed by monoclonal abnormal proliferation of plasma cells, which is mainly characterized by localized masses and very rare in the larynx, particularly in the false vocal cord. We present a larynx EMP that arises from the false cord without systematic involvement. After surgical resection, the patient received adjuvant radiotherapy and was recurrence-free during the 8-month follow-up. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare survival outcomes in patients with perineural invasion (PNI)-positive laryngeal squamous cell carcinoma (LSCC) and patients with PNI-negative LSCC. A total of 1,272 patients with LSCC, diagnosed between 2008 and 2017, were included in this study. LSCC Patients with and without PNI were matched based on possible confounding factors. Survival analysis was performed using Kaplan–Meier estimates and the Cox proportional hazards model. Of the 1,272 LSCC patients, 118 (9.28%) were positive for PNI. Compared to PNI-negative patients, PNI-positive LSCC patients had significantly worse overall survival (OS) (p = 0.017), disease-specific survival (DSS) (p = 0.034) and recurrence-free survival (RFS) (p = 0.002). After pair matching, cohorts consisted of 118 patients in the PNI-positive group and 118 in the PNI-negative group. Significantly increased risk of OS (HR, 2.17; 95% confidence interval [CI], 1.29–3.61, p = 0.003), DSS (HR, 2.07; 95% CI, 1.32–3.24, p = 0.004) and RFS (HR, 2.65; 95% CI, 1.59–4.40, p < 0.001) was observed after adjustment for prognostic variables. Patients with PNI-positive LSCC have significantly worse survival outcomes compared to patients with PNI-negative LSCC. [ABSTRACT FROM AUTHOR]

Objectives: Laryngeal Chondrosarcoma (LC) is a rare malignancy with limited studies documenting its clinicopathologic characteristics and treatment options. This study reports demographic and clinical determinants of outcomes for this rare tumor.Methods: The National Cancer Database (NCDB) was queried for cases of LC reported from 2004-2016. 274 cases that met inclusion criteria were analyzed for demographic and clinicopathologic characteristics. Kaplan-Meier (KM) and Cox proportional hazard analyses were conducted to identify variables that impacted the overall survival of these patients.Results: LC was found to be more common in males (74.8%). The mean age of patients was 61.8 years and 92.3% of the patients were white. 91.3% of patients were treated with only surgical resection, most commonly: partial laryngectomy (31.6%), total laryngectomy (25.7%), and local resection (22.4%). 98.8% of patients had no evidence of nodal disease and 99.6% of patients did not have distant metastasis at presentation. KM analysis revealed a 5-year overall survival (5YOS) of 89.0%. Age, insurance status, facility type, and surgery type were significant predictors of 5YOS (p<0.05). On Cox Proportional Hazard analysis, private insurance significantly improved survival (HR 0.21; p = 0.048) while increasing age was a poor prognostic indicator (HR 1.10; p = 0.004).Conclusion: The majority of LC patients present with no nodal involvement or distant metastasis at diagnosis, and overall this tumor has a favorable prognosis. Increasing age was found to be a poor prognostic factor while private insurance status was associated with improved survival. [ABSTRACT FROM AUTHOR]

Objectives: The goal of this study was to evaluate the benefit of sublesional bevacizumab injection for recurrent respiratory papillomatosis (RRP) as used in a typical clinical practice. Methods: A retrospective review of patients with RRP treated between 2011 and 2016 was undertaken. All patients were treated with in-office potassium titanyl phosphate (KTP) laser photoablation. Sublesional bevacizumab injection was used based on joint patient-physician decision making. Papilloma burden was objectively measured on prior recordings by 2 blinded reviewers and described as vocal fold segments affected (VFSA) by papilloma. Each patient served as their own control by comparing times when bevacizumab was or was not used. Mixed model for longitudinal data was used to determine if the previous use of bevacizumab decreased the disease burden. Results: A total of 19 patients met inclusion criteria and all prior laryngoscopic exams were reviewed for VFSA as described above. The mean (SD) number of VFSA when bevacizumab was not used at the prior procedure was 15 (14) as compared to 8 (11) when bevacizumab was used. When adjusted for age, time from initial presentation and baseline disease burden, mixed model showed a decrease of 11 VFSA (95% CI 6.5, 15.5, P <.0001) when bevacizumab was used as compared to when bevacizumab was not used at the prior procedure. In mixed model analysis, there was not a significant association between bevacizumab dose used and VFSA at the subsequent visit (P =.8). Conclusion: Using sublesional bevacizumab intermittently based on clinical findings appears to be effective in improving disease control. Papilloma burden is significantly decreased at the subsequent clinical follow-up following injection of sublesional bevacizumab. The beneficial effect of sublesional bevacizumab may be not be dose-dependent. [ABSTRACT FROM AUTHOR]

Radical (chemo)radiotherapy offers potentially curative treatment for patients with locally advanced laryngeal or hypopharyngeal cancer. We aimed to show that dose-escalated intensity-modulated radiotherapy (DE-IMRT) improved locoregional control. We performed a phase III open-label randomised controlled trial in patients with laryngeal or hypopharyngeal cancer (AJCC III-IVa/b, TNM 7). Patients were randomised (1:1) to DE-IMRT or standard dose IMRT (ST-IMRT) using a minimisation algorithm, balancing for centre, tumour site, nodal status and chemotherapy use. DE-IMRT was 67.2 gray (Gy) in 28 fractions (f) to the primary tumour and 56Gy/28f to at-risk nodes; ST-IMRT was 65Gy/30f to primary tumour and 54Gy/30f to at-risk nodes. Suitable patients received 2 cycles of concomitant cisplatin and up to 3 cycles of platinum-based induction chemotherapy. The primary end-point was time to locoregional failure analysed by intention-to-treat analysis using competing risk methodology. Between February 2011 and October 2015, 276 patients (138 ST-IMRT; 138 DE-IMRT) were randomised. A preplanned interim futility analysis met the criterion for early closure. After a median follow-up of 47.9 months (interquartile range 37.5–60.5), there were locoregional failures in 38 of 138 (27.5%) ST-IMRT patients and 42 of 138 (30.4%) DE-IMRT patients; an adjusted subhazard ratio of 1.16 (95% confidence interval: 0.74–1.83, p = 0.519) indicated no evidence of benefit with DE-IMRT. Acute grade 2 pharyngeal mucositis was reported more frequently with DE-IMRT than with ST-IMRT (42% vs. 32%). No differences in grade ≥3 acute or late toxicity rates were seen. DE-IMRT did not improve locoregional control in patients with laryngeal or hypopharyngeal cancer. The trial is registered: ISRCTN01483375. • This phase III RCT does not support dose escalation using accelerated hypofractionation. • No benefit in local tumour control or survival was seen. • Two-year local tumour failure rate was approximately 30% in both treatment groups. • The larynx was preserved in about 90% patients in both treatment groups. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the outcome of salvage total laryngectomy and identify areas for further improvement. Method: A retrospective analysis of all patients who underwent salvage total laryngectomy between January 1999 and December 2018 was performed. Results: Thirty-one patients were identified. The most common primary tumour site was the glottis (83.8 per cent). Early stage (T1–T2) disease was identified in 83.9 per cent of cases. Overall survival at 2 and 5 years post-salvage total laryngectomy was 71 per cent and 45 per cent, respectively. Disease-free survival at 2 and 5 years post-salvage total laryngectomy was 65 per cent and 42 per cent, respectively. The rate of post-salvage total laryngectomy pharyngocutaneous fistula was 29 per cent. Conclusion: More than half of patients will not survive beyond five years after salvage total laryngectomy. Regional recurrence was the most common form of failure and death. From this study, elective lateral and central neck dissection is advocated in patients with early laryngeal cancer who present with an advanced recurrence. [ABSTRACT FROM AUTHOR]

Treatment of squamous cell carcinoma of the supraglottic larynx (SCCSL) in Denmark has changed in several ways from the year 2000 to 2014, including the introduction of IMRT radiation technique and the addition of concurrent chemotherapy (CRT), as well as systematic reduction in waiting times until treatment initiation. Our aim is to investigate the effect of the abovementioned factors on overall survival (OS) and locoregional control (LC) for SCCSL patients. Retrospective cohort study with data from the DAHANCA database. We used the Kaplan–Meier and Cumulative Incidence plots as well as Cox regression analysis. We found a statistically significant improvement of the 5-year OS of 19.3 percentage points (pp). Cox regression found LC was not improved in patients receiving CRT compared to radiotherapy (RT) alone. Introduction of CRT treatment for head and neck cancers in general is known to improve LC. We could not demonstrate this effect for SCCSL specifically, as our results were not statistically significant on this point. OS was significantly improved. [ABSTRACT FROM AUTHOR]